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(Stroke. 1996;27:1274-1282.)
© 1996 American Heart Association, Inc.

Articles

Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People

The Cardiovascular Health Study

W.T. Longstreth, Jr, MD, MPH; Teri A. Manolio, MD, MHS; Alice Arnold, PhD; Gregory L. Burke, MD, MS; Nick Bryan, MD, PhD; Charles A. Jungreis, MD; Paul L. Enright, MD; Daniel O'Leary, MD; Linda Fried, MD, MPH for the Cardiovascular Health Study Collaborative Research Group

the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (A.A.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (G.L.B.); Departments of Radiology (Neuroradiology Division) (N.B.) and Medicine (L.F.), Johns Hopkins University School of Medicine, Baltimore, Md; Departments of Radiology and Neurological Surgery, University of Pittsburgh (Pa) Medical Center (C.A.J.); Respiratory Sciences Center, University of Arizona, Tucson (P.L.E.); and Department of Radiology, New England Medical Center, Boston, Mass (D.O'L.).

Correspondence to W.T. Longstreth, Jr, MD, Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104-2499. E-mail wl@u.washington.edu.

Background and Purpose Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people.

Methods Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. Correlates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologists graded white matter findings from 0 (none) to 9 (maximal) without clinical information.

Results Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P<.01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV1), and income less than $50 000 per year. If excluded, FEV1 was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade, especially those indicating impaired cognitive and lower extremity function.

Conclusions White matter findings were significantly associated with age, silent stroke, hypertension, FEV1, and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.


Key Words: aged • cognition • hypertension • magnetic resonance imaging • white matter




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